In addition to having the highest rate of people without health insurance in the nation, Texas also has the largest number of children without health insurance and the highest rate of poor adults without health insurance, according to 2012 American Community Survey estimates released by the U.S. Census Bureau late Wednesday.

More than 852,000 Texas children lacked health insurance in 2012, according to the ACS estimates, which are taken from a random sampling of households throughout the year. California, which has 2.2 million more children than Texas, had the second-highest number of uninsured children at 717,000.

Texas also had the highest rate of adults making below 138 percent of the federal poverty threshold — lower than $15,415 for an individual or $26,344 for a family of three — who lack insurance, at 55 percent. Those people would have qualified for Medicaid coverage if the state had chosen to expand eligibility under the federal Affordable Care Act.

“There is just an awful lot of people priced out of the [health insurance] market in Texas because of our Wild West regulatory approach on the rate side,” said Anne Dunkelberg, associate director of the left-leaning Center for Public Policy Priorities. She attributed the high rate of uninsured to the lack of regulations governing Texas’ individual and large employer health insurance markets, the exclusion of most poor parents and all other adults from the state’s Medicaid program, and the lack of employer-sponsored coverage in many of Texas’ predominant industries, such as agriculture, food service and construction, among other factors.

“I think that we have an unhealthy obsession with the uninsured rate in Texas,” said John Davidson, health policy analyst at the conservative Texas Public Policy Foundation. “It distracts us from the much more important question of health care for the indigent population. Insurance and care are not the same things.”

Alternative health care models, such as programs that offer sliding-scale payment rates for low-income people, can contain costs without reducing access to care, he said. For example, he cited the CareLink program run by the University Health System in Bexar County, which provides payment plans and sliding-scale rates for families who make less than 300 percent of the federal poverty level.

“Being on an insurance plan doesn’t mean you have good health care or you have access to health care,” Davidson said. “I think this is most obvious when you look at our Medicaid program,” which he said has “terrible problems with access to care.”

The ACS estimates that 1.6 million adults with incomes below 138 percent of the federal poverty threshold had insurance in 2012, while 2 million were uninsured.

Original story, Sept. 17:

Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, according to the Current Population Survey estimates released by the U.S. Census Bureau on Tuesday.

“Texas has often had the highest uninsured rate throughout the country,” said David Johnson, chief of the Census Bureau’s Social, Economic, and Housing Statistics Division. He added that additional data from the American Community Survey that the Census Bureau plans to release later this week would provide more specific information on health insurance rates in states and metropolitan areas.

The Current Population Survey estimates revealed that the national uninsured rate declined in 2012, to 15.4 percent from 15.7 percent in 2011. The national real median income and official poverty rate were not statistically different in 2011 and 2012, according to the estimates.

Overall, roughly 48 million Americans — including more than 6 million Texans — were uninsured in both 2011 and 2012. For those who had health insurance coverage, the percent with private coverage remained stagnant at close to 64 percent, while the percent enrolled in government health programs, such as Medicare or Medicaid, increased for the sixth consecutive year to 32.6 percent in 2012.

“The increase in public coverage and no statistical change in private coverage may account for the increase in overall coverage,” said Johnson.

Although more than 1 million children in Texas are uninsured, the majority of uninsured Texans are adults between the ages of 18 and 65. In total, 19.7 million Texans had health coverage during some point in 2012; 14.5 million had private coverage, while 7.3 million were covered by government health insurance.

On Monday, Gov. Rick Perry reiterated his opposition to solving the state’s uninsured problem by expanding Medicaid to low-income adults and instead directed the state agency that oversees the program to pursue permission to reform the program.

Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, continue asset- and resource testing to determine eligibility, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote in a letter to the agency.

If Texas had chosen to expand Medicaid eligibility under the Affordable Care Act to include impoverished adults below 138 percent of the federal poverty level, the program could have extended coverage to an additional 2 million people, according to a report by Billy Hamilton, former deputy state comptroller and fiscal consultant.

The federal government would have covered 100 percent of those recipients’ benefits for three years, and then reduced its share to 90 percent in later years. In the 2014-15 biennium, Texas would have received $7.7 billion in federal funds, while spending $297 million to cover poor adults, according to Hamilton’s estimates. Medicaid expansion would have cost the state six times less than the amount local governments and hospitals currently on uncompensated care for uninsured adults, according to Hamilton’s report.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

BECCA AARONSON reports for The Texas Tribune where this story was originally published. It is made available here through a news partnership between the Texas Tribune and the San Marcos Mercury.